Organization
CLARKSTON DERMATOLOGY & VEIN CENTER PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WENDY L MCFALDA D.O. (MEMBER)
(248) 620-3376
Entity
Organization
Contact information
Practice address
5701 BOW POINTE DR, SUITE 215, CLARKSTON, MI 48346-3198
(248) 620-3376
(248) 620-3379
Mailing address
5701 BOW POINTE DR, SUITE 215, CLARKSTON, MI 48346-3198
(248) 620-3376
(248) 620-3379
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
5101014699
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0756301335
BLUE CARE NETWORK
MI
01
—
0P14750
MEDICARE PLUS BLUE
MI
01
—
DD8092
MEDICARE RAILROAD
MI
Enumeration date
02/27/2007
Last updated
06/08/2015
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